Monday September 4,2017

    We arrived last night after a long but uneventful flight. Perhaps the best thing about the trip was that I could use my Priority Pass for all of us to enjoy the departure  lounges at JFK and again in Brussels. But its still a long flight and just not that enjoyable. We came from the airport into Monrovia to stay at the Murex Plaza Hotel, which is where we stayed last March and enjoyed it a lot. Before coming to the hotel we stopped at the JFK Administration Building to drop off the 9 duffel bags of supplies we brought with us. While we were there, Munah I'm very pleased that we are staying here again ! After a late dinner we retired, and then Jonathan and Chandra arrived so I got up to greet them briefly.
     The team this time includes Dr. Jonathan Laryea and myself; Jonathan is a former resident of ours at Waterbury Hospital who is now a colo-rectal surgeon at the University of Arkansas for Medical Sciences. I think this is his 7th trip to Liberia. Also on the team is Dr.Chandra Joshi, an anesthesiologist at Mass who was here once before; Dr. Sandeep Sachidananda, one of our Chief Residents at Waterbury Hospital; Dr. Greg Ricketts, a PGY-3 in our program; and Ms. Murphy Pena, a scrub tech at Waterbury Hospital.
     After breakfast we went to the hospital to see our friends.We stopped in at surgical chart rounds where we were greeted happily by all present including Dr. Gbozee; this was his return to work day after his month in the USA. We went on a quick tour of the hospital, and learned that we will be able to use the Ors on the 4th floor starting today !! We will use the old general surgery room looking out on the shantytown and ocean, and also the Ortho room next door. Prior to our arrival there was some question about what we would use for ORs; this is the best possible result !!
      Grand Rounds was a visiting radiologist from the USA who talked about using the ultrasound to get necessary clinical information. It was quite a good presentation, and I learned from it. I told Murphy yesterday that today would likely be a slow day as we got organized; obviously I had forgotten where we were ! We ended up doing 3 operations (2 ruptured appendix, one baby with an imperforate anus who needed a colostomy) and saw a multitude of consults some of which we will be able to help through surgery, but others for which we have neither the resources or talent. We saw a 17 year old boy with a huge tumor on the left side of his jaw; this is most likely an ameloblastoma, which is an unusual tumor dental enamel. It is benign, but locally aggressive; the only treatment is surgery which typically involved removing some of the mandible and then reconstructing it with a rib.These surgeries usually involve a team of specialists including maxillo-facial surgery, dental surgery, and plastic surgery; Liberia has none of those specialists, so we will try to find an alternative solution for this unfortunate young man.
      After we finished surgery around 8:30,we went to see a 4 year old with an esophageal stricture due to lye ingestion.I have written before about these cases; we see them frequently here, and it is a serious public health problem.the victims are mostly kids who have no idea that the clear water their Mom put in the Coke bottle is not water, but rather a highly concentrated alkali solution. This effectively burns the layers of the esophagus, and then it forms a hard scar, effectively closing off the esophagus. For the boy we saw, it has been over a year since he drank the lye, and he is now unable to swallow food or liquid. The only possible solution for him is a major surgical procedure for which there is neither the talent nor the resources to perform in Liberia. We will be reaching out for advice and help.
     After dinner at 9:30PM, the end to a long day. Despite everything, Liberia is a happy place for me.With each visit, I see progress, and I love my friends here.